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"On February 4, 2009, President Obama signed the Children's Health Insurance Program (CHIP) Reauthorization Act into law. Among other things, the new law increases funding for state Children's Health Insurance Programs (CHIPs) and makes a number of administrative changes to the program. In addition, the act allows states to subsidize premiums for employer-sponsored group health coverage, (not the same as the federal COBRA subsidy), and establishes new HIPAA special enrollment rights for individuals who either lose Medicaid or CHIP-funded medical coverage, or those who become eligible for a premium subsidy. Groups are required to provide an annual notice of these special enrollment rights to employees. Groups are also required to disclose benefit information to a state Medicaid agency upon request".

The Internal Revenue Code, ERISA and the Public Health Service Act are amended to permit a HIPPA special enrollment effective April 1, 2009 under two circumstances.

  • Loss of Medicaid or CHIP eligibility - an employee or dependent enrolled in one of these programs and loses their eligibility, may enroll in the group plan within 60 days of the loss, and is eligible for your group benefits.
  • Becoming eligible for premium assistance - when an 'eligible' employee or dependent that is not in your group plan becomes eligible for premium assistance, they may enroll within 60 days of becoming eligible.
"Groups in states like Minnesota with Medicaid and CHIP must annually notify each employee about the potential opportunities for premium assistance for the employee or the employee's dependents. The Secretary of Health and Human Services, in consultation with the Medicaid directors, must jointly develop model notices for employers to use. While groups are not required to notify employees of the new special enrollment right until the model notice is ready (beginning in 2010), Blue Cross has developed model notice language an employer could use to alert their employees now. This language can be found on our website and copied to your company stationery."

More information is trickling in as I write this. Special enrollment periods are a moot point for those of you with less than 50 employees because in Minnesota 'small reformed group' allows for an eligible employee or dependent to enroll at any time. The pre-existing limitation period can be affected if one does not enroll in a timely fashion, but the enrollment option has always been there. For companies with more than 50 employees (working 20+ hours a week), the loss of CHIP or Medicaid eligibility, or qualifying for premium assistance, would entitle an 'eligible' employee or dependent to a special enrollment period.

If you have questions or concerns, please feel free to contact me at your convenience.


Children's Health Insurance Program (CHIP) Reauthorization Act and special enrollment eligibility period; Blue Cross Group Leader Bulletin, March 2009

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